 |
 |
 |
|
||
 |
|
 |
|
||
|
|
|
|
||
|
|
|
|
||
by Julie Grimstad
The dehumanizing label "persistent vegetative state" (PVS) was crafted in 1972 just as the euthanasia movement began to take on steam. It became more familiar in the 1980s as neurologists began to use it as justification for withdrawing food and fluids from otherwise non-dying brain-injured patients.
Many people have blind faith in medical labeling. Most probably think that PVS is a simple diagnosis. However, experts disagree about what it is and methods for diagnostic testing are disputed. PVS is grouped in the International Classification of Diseases with "Symptoms, Signs and Ill-Defined Conditions."
A "vegetative state" is not a coma. According to the 1994 Multi-Society Task Force on the medical aspects of PVS (MTSF), a person in a coma is neither awake nor aware; a person in a vegetative state is awake but not aware. The MTSF defined a persistent vegetative state as a vegetative state that lasts more than one month.1
The person in PVS has sleep-wake cycles, eye movement, and normal respiratory, circulatory, and digestive functions. Some have random movement, some do not; some can swallow, others cannot. Some have been physically injured, others suffer from stroke or dementia. In some cases the brain itself appears to change, in others it appears unchanged.
In simple terms, the diagnosis of PVS is based on a lack of evidence of awareness of self or environment. However, it is not that simple.
Some patients who are diagnosed to be in PVS do exhibit evidence of awareness, but the diagnostician misses (or dismisses) the evidence. They may be mute and immobile ("locked-in"), but mentally alert and able to communicate by blinking or through aids such as computers - if someone gives them the opportunity. Other patients retain some measure of awareness even though they do not exhibit any evidence of it. Patients who have recovered from such a state can recall things that were said or done to them while no one knew they were aware.
How reliable, then, is the diagnosis of PVS?
In 2002, a study of mistaken diagnosis of PVS revealed a 15% error rate.2
Data gathered by the MTSF on a group of 434 adult patients who were in PVS as a result of traumatic injury showed that three months after injury, 33% of the patients had regained consciousness; by six months, 46% had; and at 12 months, 52% had.3
Out of 40 patients diagnosed as being in PVS, 17 (43%) were later found to be alert, aware, and often able to express a simple wish. The author, London neurologist Dr. Keith Andrews, said, "It is disturbing to think that some patients who were aware had for several years been treated as being vegetative."4
A study of 84 patients with a "firm diagnosis" of PVS found that 41% regained consciousness by six months, 52% by one year, and 58% by three years.5
Studies show that PVS patients feel pain. Indeed, a University of Michigan neurologist, in one of the most complete studies, concluded that, when food and fluids are withdrawn [to impose death], the patient should be sedated.
Some objections to imposed death for patients in PVS have rested on the hope that "they might recover." Let's face it: many people with disabilities will not recover. Killing them is not a cure - it is a "final solution."
It is now common for severely brain-injured patients who are not dispatched by dehydration to wind up warehoused in nursing homes, deprived of rehabilitation and other beneficial therapy. The unconscious world is far more complex than most of us can imagine. Those who have severe brain damage may still enjoy touch, scent, taste, and sound; they may also feel loneliness, fear, and despair.
Their inability to satisfy our longing for response does not justify abandonment or imposed death.
Notes:
1. Mappes, Thomas A., "Persistent Vegetative State, Prospective Thinking, and Advance Directives," Kennedy Institute of Ethics Journal, 2003:Vol. 13, No. 2: 119-139
2. Ibid
3. Ibid
4. British Medical Journal, 7/6/96.
5. British Medical Journal, 8/92:304-305.
6. Detroit Free Press, 6/26/90:10A
Julie Grimstad is the primary writer and editor of Euthanasia: Imposed Death. She is the executive director of Life is Worth Living, Inc., whose members are dedicated to the authentic restoration of respect for human life. Julie co-founded and served as the director of the Center for the Rights of the Terminally Ill from 1985 to 2003. A patient advocate, public speaker and writer, she is recognized for her long-standing focus on end-of-life issues. She resides in Stevens Point, WI. Julie may be contacted by email at lifeisworthliving@sbcglobal.net.
